Diagnostic work-up and surgery in participants of the Gdansk lung cancer screening programme: the incidence of surgery for non-malignant conditions
Diagnostic work-up and surgery in participants of the Gdansk lung cancer screening programme: the incidence of surgery for non-malignant conditions
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DOI：
10.1093/icvts/ivt388
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发表时间：
2013-12-01
影响因子：
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通讯作者：
Marjanski, Tomasz
中科院分区：
文献类型：
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作者：
Rzyman, Witold;Jelitto-Gorska, Malgorzata;Marjanski, Tomasz
低剂量计算机断层扫描（LDCT）筛查改善了肺癌的预后，但也导致许多没有癌症的个体进行诊断检查和手术治疗。因此，我们分析了筛查参与者接受的程序，以更好地了解过度诊断的程度。2009 - 2011年间，8649名年龄在50-75岁、吸烟史为20包年的健康志愿者接受了LDCT筛查，其中发现肺结节的个体对照组为2年。结节直径为bbb10 mm或疑似肿瘤形态的参与者接受了诊断性检查：283(6%)/4694（54%）筛查参与者检测到肺结节。104人接受了手术，27人接受了肿瘤治疗，152人没有癌症诊断，他们接受了LDCT的进一步随访。在接受诊断性检查的75%的参与者和25%的手术患者中，手术是不必要的。在70例（24.7%）参与者中，获得特异性诊断主要是由于细针穿刺活检的低疗效[敏感性，65.2%；LDCT过度解读导致的阴性预测值（NPV, 95.9%）和纤维支气管镜检查（敏感性，71.4%；NPV, 50%）[阳性预测值（PPV）， 2%]。104例（36.7%）手术患者中，43例（41.4%）术前已确诊为肿瘤，61例（58.6%）手术未做病理检查。在后一组中，有35例（57.3%）患者的干预是合理的。49例（17.3%）接受诊断检查的参与者出现并发症。手术患者中，67例（64.4%）恶性病变被切除，37例（35.6%）良性病变被切除。在后一组中，只有11例（29.7%）患者的干预是合理的。在研究期间，没有患者因诊断或治疗程序而死亡。恶性组并发症发生率为14.5%，良性组为10.8%。94名筛查参与者中发现肿瘤，其中67人（71.3%）接受了手术；其余27例（28.7%）患者不适合手术。在接受非小细胞肺癌（NSCLC）手术的患者中，腺癌占49/67 (73%)；56/67（84%）患者为I期NSCLC， 26/67（38%）患者行胸腔镜肺叶切除术。在广泛应用LDCT筛查之前，必须减少无用的诊断检查和手术。接受手术的非小细胞肺癌患者以I期腺癌为主。
Low-dose computed tomography (LDCT) screening improves lung cancer prognosis but also results in diagnostic work-up and surgical treatment in many individuals without cancer. Therefore, we analysed the procedures that screening participants underwent to better understand the extent of overdiagnosis.Between 2009 and 2011, 8649 healthy volunteers aged 50-75 years with a 20 pack-year smoking history underwent LDCT screening, of whom individuals with detected lung nodules had 2 years control. Participants with a nodule > 10 mm in diameter or with suspected tumour morphology underwent diagnostic work-up: 283 (6%)/4694 (54%) screened participants had detected lung nodules. One hundred and four individuals underwent surgery, 27 underwent oncological treatment and 152 without a cancer diagnosis underwent further follow-up with LDCT.In 75% of participants accepted for diagnostic work-up and 25% of surgical patients, the procedures were unnecessary. In 70 (24.7%) participants, a specific diagnosis was obtained mainly due to the low efficacy of fine needle aspiration biopsy [sensitivity, 65.2%; negative predictive value (NPV), 95.9%] and bronchofiberoscopy (sensitivity, 71.4%; NPV, 50%) caused by overinterpretation of LDCT [positive predictive value (PPV), 2%]. Of 104 (36.7%) surgical patients, 43 (41.4%) had a preoperative cancer diagnosis, and 61 (58.6%) underwent surgery without pathological examination. In the latter group, intervention was justified in 35 (57.3%) patients. Complications occurred in 49 (17.3%) participants subjected to diagnostic work-up. In surgical patients, 67 (64.4%) malignant and 37 (35.6%) benign lesions were resected. In the latter group, intervention was justified in only 11 (29.7%) patients. No patient died because of diagnostic or treatment procedures during the study. The complication rate was 14.5% in the malignant and 10.8% in the benign groups. A neoplasm was found in 94 screening participants, of whom 67 (71.3%) underwent surgery; the remaining 27 (28.7%) patients were not surgical candidates. Adenocarcinoma accounted for 49/67 (73%) patients who underwent surgery for non-small-cell lung cancer (NSCLC); 56/67 (84%) patients had stage I NSCLC, and 26/67 (38%) underwent video-assisted thoracoscopic surgery lobectomy.Futile diagnostic work-ups and operations must be reduced before LDCT screening can be broadly used. Stage I adenocarcinoma dominated in the NSCLC patients who underwent surgery.